Greg Alexander

Providing comfort in difficult times

Baltimore Sun, July 16, 2006

In many areas of health care today, nurses and allied health professionals are not able to spend a great deal of quality time with patients due to the hectic environment and staff shortages, a frustrating fact of life for those who chose these career paths because they wanted to provide a healing touch and treasured the opportunity to bond with their patients. Luckily, there still is one facet of health care where the opportunity still presents itself to really take the time to get to know the patients and provide that personal touch.

Hospice care, a unique aspect of health care that concentrates on providing comfort, pain management and symptom control for patients with life-limiting illnesses, is structured in a way that emphasizes direct, one-on-one patient care, allowing health care workers to spend a great deal of time with patients and their families. “I had worked as a surgical operating room nurse, but I wanted to get back into direct patient care where I could really provide that personal touch that comes with being a nurse,” says Beth Stem, BSN, RN, of Hospice of Baltimore, an affiliate of Greater Baltimore Medical Center. “In hospice, you get to work with the patient and his or her whole family in an intimate setting. The family invites you into their home and into the private parts of their lives. It’s unlike anything else.”

Stem says that one of the unique aspects of hospice care is that it allows her to use her skills on an educational, emotional, spiritual and clinical level. In order to address these varied areas, a team-based approach is typically used, says Lisa Stone, senior vice president of outreach services at Stella Maris, a part of Mercy Health Services. “Nurses, social workers, pastoral care workers, nurse practioners, pharmacists, dieticians, home health aids and volunteers all contribute,” says Stone, who adds that Stella Maris provides care at the patient’s home, long-term care facility, as well as in an inpatient setting. “It’s done wherever the patient considers home,” she says. “People often ask, ‘How can someone work in an environment where you have to deal with death so often?’ I tell them that I find peace when dealing with end-of-life issues. You are helping the patient as well as the family, and every life story is different.”

Something else that is different in hospice care is the array of illnesses that health care workers now address. “Hospice used to only be about cancer,” says Stem, “but now we care for patients with Alzheimer’s, congestive heart failure, Parkinson’s and other illnesses. “A much broader skill set is needed for those moving into hospice care,” agrees Regina Bodnar, RN, MS, MSN, CHPN, director of clinical services of Hospice of Baltimore. “I was an oncology nurse for many years before I moved into hospice care, and most of my colleagues were oncology nurses since most hospice patients were cancer patients. Now, we have nurses from emergency room, intensive care and home care settings. No matter what your background is, hospice is an incredible career opportunity. It marries your skills and talents with the opportunity to foster and build close relationships with the patient and family.”

Bodnar cautions, though, that although hospice care workers become close to the patients and their families, “you must remember that you are not family and must remain professional. At times, you have to make strong recommendations to the physicians or treatment recommendations to the family, so strong clinical skills are important. In hospice, there are no ‘do-overs.’ You have to get it right the first time.”

“Professionalism and establishing boundaries are necessary, but a warm heart, empathy and spirituality are really strong in end-of-life care. You touch their heart and they touch yours, so it’s really hard sometimes not to cross that line; however, I have to remain professional or it would be emotionally draining,” adds Stem.

Bodnar and Stone agree that most employed in hospice care are experienced health care workers that have transitioned from a hospital setting. “We are really growing in all areas, and I’m involved in all hires – nurses, social workers, chaplains, etc. – and we need people that have strong clinical skills, communicate well and will represent the concept of hospice well in the community,” says Bodnar. “We don’t hire too many new grads from nursing school,” adds Stone. “I recommend that new grads get experience first in a hospital. Working in hospice is not for everyone. You have to be able to deal with death, offer a calming voice and support and be able to take care of both the patient and the family. I look for people who are compassionate and experienced. I also want to know what drove the individual to consider hospice as a career choice. You don’t just wake up one day and decide to work in hospice.”

Stone adds that on-the-job training is used for those making the transition into hospice. “We train in pain management, providing comfort and how to help the family in the various stages of grief,” she says.

Stem, who has been with Hospice of Baltimore for a year and a half, says that working in a hospital setting taught her acute care, while “hospice has taught me how the disease affects the body in the terminal stages. It’s a completely different part of nursing. I focus now on making the patient comfortable.” Stem says that a big part of her training was increasing her knowledge of medications. “With end-of-life patients, there are sometimes different issues such as the patient being unable to swallow pills easily. The great thing is that I have a whole team of professionals to rely on. Medical directors are on call if I need them, as well as those with doctor of pharmacy degrees. I learned with one patient, for example, that the pills that he was having difficulty swallowing could be made into gel form and be rubbed on the skin.”

For those in hospice care, one constant remains: everyone loves the work. “I can’t imagine doing anything else; it’s such a rewarding specialty,” says Bodnar. “This is the best place I’ve ever worked. I wake up every day and look forward to going to work,” adds Stem.

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